Premium
Active care of infants born between 22 and 26 weeks of gestation does not follow consensus expert recommendations
Author(s) -
Sinclair Ruth,
Bajuk Barbara,
Guaran Robert,
Challis Daniel,
Sheils Joanne,
AbdelLatif Mohamed E.,
Hilder Lisa,
Wright Ian M.,
Oei Ju Lee
Publication year - 2019
Publication title -
acta paediatrica
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.772
H-Index - 115
eISSN - 1651-2227
pISSN - 0803-5253
DOI - 10.1111/apa.14714
Subject(s) - medicine , gestation , resuscitation , caesarean delivery , obstetrics , neonatal intensive care unit , population , pediatrics , odds ratio , neonatal resuscitation , pregnancy , caesarean section , emergency medicine , genetics , environmental health , biology
Aim To determine the relationship between clinical practice and publication of an Australian consensus statement for management of extremely preterm infants in 2006. Methods A population‐based study using linked data from New South Wales, Australia for births between 22 + 0 and 26 + 6 weeks of gestation between 2000 and 2011. Results There were 4746 births of whom 2870 were liveborn and 1876 were stillborn. Of the live births, 2041 (71%) were resuscitated, 1914 (67%) were admitted into a neonatal intensive care unit ( NICU ) and 1310 (46%) survived to hospital discharge. Thirty‐nine (2%) stillbirths were resuscitated but none survived. No 22‐week infant survived to hospital discharge. Fewer 23‐week gestation infants were resuscitated between 2004 (52%) and 2005 (20%) but resuscitation rates increased by 2008 (44%). There was no difference at other gestations. Adjusted odds ratio ( OR ) for resuscitation was increased by birthweight ( OR : 1.01), tertiary hospital birth ( OR : 3.4) and Caesarean delivery ( OR : 11.3) and decreased by rural residence ( OR : 0.4) and male gender (OR: 0.7). Conclusion Expert recommendations may be shaped by clinical practice rather than the converse, especially for 23‐week gestation infants. Recommendations should be revised regularly to include clinical practice changes.